Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00093
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/9/2007
PARCEL: 2S 102CB -02300
SITE ADDRESS: 13240 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT: 008 JURISDICTION: TIG
PROJECT: PACIFIC MEDICAL
Project Description: Limited energy for HVAC.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL,# OF SYSTEMS: 1
Owner: Contractor:
PACIFIC PROPERTIES WILLAMETTE HVAC
•
BY MARTIN JOHNSON PO BOX 23334
13200 SW PACIFIC HWY TIGARD, OR 97281
TIGARD, OR 97223
Phone: Contact #: PRI 503- 628 -6841
•
FAX 503- 848 -2597
FEES Reg #: ELE 34- 346CRE
LIC 56951
Description Date Amount
[ELPRMT] ELR Permit 4/9/2007 . $75.00
[TAX] 8% State Surcha 4/9/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This. permit will expire if work is not started ithin 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules ad Med by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may o,/ ain copies of these
rules or -c • • -stions to OUNC at 503.246.6699 or 1.800.332.2344. J��
Issued = � / �
, � I Permittee Signature: ei�!/"
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: . DATE:
•
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application !j FOR OFFICE USE ONLY
City of Tigard Date/By: y: Q / Permit No.: g -az
et III 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
G Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
•
TI G A It D Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: r a Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:. where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps'at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2: family dwelling 'Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: l 9 R ' -. ✓ ❑ Six or or more residential Recreational
C / Six or more residential units. ❑R vehicle parks.
ty % Gv q 92 g. L City/State/ZIP: �� p� ❑ Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: P�rc: 1e/G 1 ,04 / ❑ Service or feeder 600 amps or more.
- FEE SCHEDULE
Cross street/directions to job site: Description I Qty'. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2 •
DESCRIPTION OF WORK (with above sq. ft.)
� L energy, multi - family
/( ./'G.t..C, l4 e.w�0-S residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 . 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone; ( ) Fax: ( ) • 200 amps or less 66.85 • 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps _ 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
. each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'i branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( • ) Fax: : ( ) Reconnect only 66.85 .2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR .Sign.or outline lighting 53.40 2
, �f
Business name: �,) liot,vtG/ ' C /-(1.04C Signal circuit(s) or limited -
energy panel, alteration, or
Address: /3 ? ?7" extension. Describe: ,. Page 2 2
City/State /ZIP: —I..-- O,v ti� eZ:), 4. 9.. &( Each additional inspection over allowable in any of the above
40 n 7 Per inspection 62.50
Phone:
( 3 ca _ t� Fax: �e.�) 8 .`�8'. 75 'rg i r Investigation per hour (I hr min) 62.50
CCB Lic: 'I 51 Electrical Lic ,F/ 4 ,. 5' f Su . Lic.: Industrial plant per hour 73.75
®�� ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ..9„,/Z. Subtotal: '7
Print name: w/��� ��,� Date: e9 c) Plan review (25% of permit fee):
` State surcharge (8% of permit fee): £- C0
Authorized signature: TOTAL PERMIT FEE: S I ,6.0
This permit application expires If a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1 :\ Building \ Permits \ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB
Electrical. Permit Application - City of.Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
j RESIDENTIAL WORK ONLY: �}
Fee for all residential systems combined $75.00 •
Check Type of Work Involved: •
• ❑ Audio and Stereo Systems*
❑ Burglar Alarm •
❑ Garage Door Opener*
eatin Ventilation and Air Conditioning System*
❑ Vacuum Systems* •
❑ Other:
( WORK ONLY
Fee for each commercial • $75.00
system
. (SEE OAR 918 - 260 -260) •
Check Type of Work Involved: •
•
❑ Audio and Stereo Systems
❑ Boiler Controls •
❑ Clock Systems
•
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
•
❑ Instrumentation
❑ Intercom and Paging Systems •
❑ Landscape Irrigation Control*
❑ Medical
• ❑ Nurse Calls •
❑ Outdoor. Landscape Lighting* .
•
❑ Protective Signaling
❑ Other •
Total number of commercial systems:
*No licenses are required.. Licenses are required .
for all other installations •
I:\Building'Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00093
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/9/2007
Phone: (503) 639- 4171r -ti
Inspection Requests (24 Hrs.): (503) 639 -4175 :_..
INSPECTION WORKSHEET FOR DATE: 5/31/2007 TIME: 7:00AM PAGE: 58
SITE ADDRESS: 13240 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FREWINCS ORCHARD TRACTS LOT #: 008 TYPE OF USE:
PROJECT NAME: PACIFIC MEDICAL
DESCRIPTION: Limited energy for HVAC.
OWNER: PACIFIC PROPERTIES, PHONE #:
CONTRACTOR: WILLAMETTE HVAC PHONE #: 503-628-6841
Inspection Request Scheduled For: Date: 5/31/2007 Pour Time:
Code # Inspection Description iP - Contact # Message
199 Electrical final 0 49311 -01 503- 752 -4985 Y
AN
Corrections/Comments/Instructions: —�
L C 9
&AS I
\PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / It4 (1 / 4 % Date: 61 11 01 Phone #: (503) 718 - 1.041ii0